pre-empt newsletter: issue 6; sept., 2012 newsletter... · coffee mugs to acknowledge the...
TRANSCRIPT
2012 CIHR Knowledge Translation prize
Congratulations to Dr Peter von Dadelszen
“This package is, quite simply, an overwhelmingly impressive account of
work of immense quality and far-reaching impact. The work in KT is exemplary
in employing sound research methods and in evaluating the impact on health
outcomes of the dissemination of the KT materials. This is, quite frankly, an
outstanding application.” And, “The letters of nomination…are the strongest
letters I have ever read about anyone for any award! They document the incredi-
ble national and international impact that Dr von Dadelszen‟s contributions
have had to women‟s health around the world, and the tremendous recognition
he has received and is receiving.”
These were the words of two Canadian Institutes of Health Research (CIHR)
reviewers who chose our very own Dr Peter von Dadelszen‟s nomination over
16 others for the prestigious 2012 CIHR Knowledge Translation (KT) Prize of
$100,000. The CIHR KT Prize honours and supports the exemplary KT efforts
and activities of an exceptional individual, team, or organization that has made
an outstanding contribution to increasing the application of research findings,
improving the health of individuals, improving health services and products, or
strengthening the health-care system. Dr Matthews Mathai, Coordinator for
Epidemiology, Monitoring & Evaluation, Maternal & Perinatal Health Depart-
ment, WHO and PI for PRE-EMPT Objective 5: KT, nominated Peter. His
nomination letter outlines Peter‟s impressive international accomplishments
related both to pre-eclampsia basic science and health services research KT
activities. He wrote, “How has Peter achieved this remarkable track record of
KT with such a broad range of international partners? In my opinion it is his
patent knowledge of his topic, his respectful and open manner that invites con-
tributions from global partners, and the esteem in which he is held by those
partners, that has led to his international pre-eminence in the area of global
woman‟s health, and pre-eclampsia especially. You hear his name mentioned
everywhere.” The Society of Obstetricians and Gynecologists of Canada
(SOGC) also supported Peter‟s nomination. They recognized Peter‟s pioneering
achievements in development of the PIERS predictive models, co-authorship of
numerous SOGC clinical practice guidelines, and numerous published strategic
KT implementation studies that utilize pre-post implementation designs to
measure guideline impact at population levels.
What will Peter do with the $100,000 associated with the award? Peter states,
“While a personal recognition, in my mind this award recognizes the creativity,
immense amount of work, and attention to detail that our group has developed
and maintained over the past 12 years. My plan is to use the funds to complete
the fullPIERS modelling process (external validation), so that the fullPIERS
model can be used to improve maternal and perinatal health outcomes interna-
tionally. Through new and existing international partnerships, we will leverage
these funds to create a fully powered fullPIERS validation data set, externally
validate the existing model, and, if appropriate, recalibrate the fullPIERS
model.” miniPIERS has been developed and validated as the primary focus of
PRE-EMPT Objective 2.The PRE-EMPT and global pre-eclampsia community
extend their warmest congratulations to Peter. We have all witnessed his com-
mitment, service, personal sacrifice, time away from his family, and unending
devotion to the cause of alleviating the global burden of pre-eclampsia. We also
extend our gratitude to the CIHR for this award in recognition of Peter‟s ex-
traordinary achievements and contributions.
Dr. Diane Sawchuck, RN, PhD
PRE-EMPT NEWSLETTER : ISSUE 6 ; SEPT . , 2012
PRE-EMPT News
The logo focuses on the current WHO data on maternal mortality ratios in Africa and
South Asia
Recent Activity
The PRE-EMPT newsletter is designed
for those involved in this project. We
hope this publication will keep you up to
date on current and upcoming activities,
important project changes and accom-
plishments by the team. The newsletter
will be distributed bimonthly, with the
next issue scheduled for the end of No-
vember. We welcome submissions of
project updates by any team member for
inclusion in the newsletter. Please sub-
WHO Working Group
Meeting on Maternal
Mortality & Morbidity,
Montreux, Switzerland
August 28-31
Global Pregnancy
CoLaboratory Second
Annual Meeting, Oriel
College, Oxford, United
Kingdom
September
3-6
Members at the Annual Global Pregnancy
Colaboraotry meeting, Page.3
P R E - E M P T N E W S L E T T E R : I S S U E 6 ; S E P T . , 2 0 1 2 P A G E 2
drafted and is being reviewed by all co-authors.
Next up for the Monitoring group in PRE-EMPT will be to
work on secondary analysis of the PIERS data including assess-
ment of risk factors for perinatal outcomes, development of the
genPIERS model, and more in-depth assessment of site specific
data.
If any collaborator has an idea they think can be tested using the
PIERS data, please submit it to Beth at [email protected] . The
intent is to make the PIERS data as accessible as possible, but
all applications for use of the data must first be approved by the
Working Group.
How high risk are our participants?
We have looked at the previous pregnancy history of the first
186 women recruited (thanks to Tina Purnat for producing the
data). Of the women recruited, 59% had early onset pre-
eclampsia (< 30 weeks) in their previous pregnancy, 16% had
ecalmpsia, 60% had very preterm birth <34 weeks, and 49% had
stillbirths. This indicates that they are a very high risk group of
women. Of the first 7 pregnancies to end, there have been 3
miscarriages, 2 women with pre-eclampsia, and 2 women with
neither complication. While these numbers are too small to
draw any conclusions, they are consistent with our expectation
that we are selecting a high risk group of women, and that the
rate of pre-eclampsia in the placebo group may well be greater
than the 25% used for our sample size calculation.
Publications: Apart from publication of our protocol, we are
working on two further reports: a systematic review of low-
dose calcium supplementation in pregnancy; and a sub-study of
the effect of low-dose calcium supplementation on non-pregnant
women with previous pre-eclampsia.
(Pictures on Page 4)
The miniPIERS model development and validation study is
now complete. The final miniPIERS model included: gesta-
tional age on admission; chest pain/ dyspnoea; headache/
visual disturbances; vaginal bleeding with abdominal pain;
right upper quadrant pain; systolic blood pressure; and dip-
stick proteinuria. This model was well-calibrated and had
reasonable discrimination ability with an area under the curve
of the receiver operating characteristic of 0.760 (95% CI
0.715 – 0.804). A cut-off of predicted probability ≥25% to
define a positive test in the development cohort resulted in a
positive likelihood ratio of 7.04 (95% CI 5.10 – 9.72) and
classified women with 82.8% accuracy; results from the vali-
dation cohorts were similar. The final publication has been
In this randomized trial, women with previous pre-eclampsia
and planning another pregnancy receive calcium 500mg daily
versus placebo from before pregnancy until 20 weeks.
Recruitment: At the end of August, we achieved our second
milestone, recruitment of 180 women. More importantly,
recruitment shows a steady upward trend. Recruitment on 20
September was 193. Strategies to further improve recruit-
ment include:
Production of „Calcium trial research collaboration‟
coffee mugs to acknowledge the contribution of antenatal
clinics who assist with recruitment.
Additional research sites at Stellenbosch University,
South Africa, and 3 clinics in Argentina.
We plan to widen the inclusion criteria to include
women with previous pre-eclampsia and current non-
proteinuric hypertension. These women are at particularly
high risk, and stand to benefit from calcium supplementation
(if indeed calcium supplementation is effective) in terms of
recurrence of pre-eclampsia in the next pregnancy. Pre-
eclampsia will be diagnosed by development of new protein-
uria in the next pregnancy.
Data entry in Open Clinic is going well with 94% of
CRF‟s entered at the last count.
miniPIERS Development & Validation (PI: Peter von Dadelszen)
CAP (Calcium And Pre-eclampsia) Trial (PI:Justus Hofmeyr)
CLIP Feasibility and Trial (PI: Peter von Dadelszen)
CLIP will test the impact of a community-level package of
care to reduce adverse maternal and perinatal outcomes re-
lated to pre-eclampsia. CLIP is currently in the feasibility and
cRCT planning phase.
The CLIP Steering Committee has convened for two recent
teleconferences: August 8th and September 26th 2012. These
discussions focused on pre-eclampsia screening and triggers
for the CLIP trial.
The development of CLIP Trial pictograms is ongoing. The
images have been built on the feedback received from the CLIP
sites and Steering Committee. The CLIP Nigeria research team
has undertaken a thorough beta test with 41 women of reproduc-
tive age. Planning for beta testing in the other CLIP sites is
underway.
India has received ethics approval from the Indian Council of
Medical Research and is preparing for upcoming stakeholder
meetings to be held in Belgaum in October.
P R E - E C L A M P S I A - E C L A M P S I A M ON I T ORI N G , P RE V E N T I ON & T RE A T M E N T P A G E 3
Annual Global Pregnancy CoLaboratory meeting, Oxford, September 3-6
The Global Pregnancy CoLaboratory continues to move forward with new projects including two large projects currently in process by
the entire group. The major event since our last report was the annual conference held at Oriel College in Oxford. Twenty members of
the steering committee attended as well as the several guests invited to present and
participate in the meeting.
The conference began with presentations from three new centers acquired since the
2011 Oxford meeting. The new members are: Stefan Hansson from Lund, Sweden;
Melissa Wilson from University of Southern California; and Yang-ling Wang from
Beijing, China. We also welcomed guests and heard presentations from the Maternal
Fetal Medicine Units network of the NICHD, Prebic, and GoNET.
Dr. Hannele Laivuori presented a brief overview of genetics in 2012 especially in
relation to preeclampsia research. She focused on how standard genetic approach,
which tends to loosen admission criteria to increase the number of subjects and im-
prove power, was absolutely counter to the principles of preeclampsia research. It
was her recommendation (and supported by discussion) that future studies of pree-
clampsia should address more homogeneous groups, such as early-onset preeclamp-
sia.
Donna Russell provided a presentation from the LINK database with a summary of information currently entered by the CoLab partici-
pants; 8 of 20 centers have entered their data. We have more than 5000 women who have biological samples drawn in early pregnancy
and who subsequently developed preeclampsia. Donna was available to work individually with the CoLab members to enter data into the
LINK database. We eagerly await the entry of the remaining data to demonstrate what a remarkable resource the CoLab provides.
Dr. Stephen Munjanja presented his views on how CoLab could help developing countries and developing countries could assist CoLab,
which has the potential to increase infrastructure in developing countries and to direct research to the areas where the need is greatest.
Les Myatt and Jim Roberts had been working on a manuscript addressing harmonization of preeclampsia research. Following a robust
discussion, members elected to form a working group that will collaborate with Dr. Myatt on harmonizing preeclampsia research. Annet-
ine Staff and her angiogenic factor data meta-analysis group reviewed progress and reported that they have data from over 14,000
women while emphasizing on the lessons learnt. Chris Redman emphasized that progress can be quite hindered if one makes a study too
complex. Finally, they established a data dictionary, which will serve as a guide towards formation of the core variable data dictionary
we are attempting to form for the CoLab.
In the discussion to attempt to identify subtypes of preeclampsia Dr. Redman emphasized the likelihood that there will be different types
of preeclampsia in developed and developing countries and Dr. Roberts stressed that there are also likely different subtypes within each
of these settings. The relevance of the subtypes is enormous. Identification of such subtypes could allow specific prediction and preven-
tion of preeclampsia subtypes. In developing countries this would be useful to risk stratify patients. A valuable resource for the studies is
a database established by the Intergrowth 21st Study of the BMFG. Dr. José Villar provided an overview, which will provide excellent
standardized data from 55,000 pregnancies from developed and developing countries. Dr. Redman reviewed the uses of this data that had
been suggested by the working group. He also presented preliminary data from Dr. Villar demonstrating that information from the data-
base was consistent with the established information about preeclampsia supporting our comfort with using this data.
In discussion about the sustainability, Dr. Per Magnus, principal investigator of MoBA, one of the largest cohorts in the CoLab, pre-
sented strategies that have been useful in maintaining this very large cohort. There was discussion of an RFA that will be announced in
the near future to study preterm birth (including preeclampsia). We concluded after extensive discussion that this RFA could, from a
scientific perspective, provide the CoLab with the opportunity to a “fill in the blanks” that were not available within the Intergrowth data
including the acquisition of biological materials. The suggested strategy was to apply for the pilot study portion of the RFA and in the 2
years of funding provided to work with investigators in the developing country to gather data to enable us to generate an algorithm for
stratifying risk or perhaps even identifying a preeclampsia subtype that might be amenable to intervention. In the next cycle we would
apply for the larger grant to do an intervention related to stratification or to prevention of preeclampsia in the selected subgroup.
One important outcome of the meeting was the decision to form working groups to address several issues which would take the direction
provided by the overall steering committee and work on specific issues and would include the current working groups in place including
those involved in the angiogenic factor study and the preeclampsia subtype study, and others but would also identify “timely topics”.
These groups would be assigned the task of facilitating research in the area that seems especially important and timely to the field, and
for which CoLab provides unique resources. The expertise in these groups would not be limited to the CoLab members but would consist
of experts recruited from around the world to work on these topics. Each working group would be assigned a specific project that would
need to be accomplished over the next 12 months. This might be the preparation of a research project but could also be a “white paper”
on appropriate approaches and targets for research. The two “timely topics” working groups for 2012 - 2013 will address the genetics of
preeclampsia and the placenta in preeclampsia. The formal sessions of the group were complemented by informal interactions greatly
facilitated by the lovely setting of Oriel College. The meeting was productive and successful, providing a vision for the near future and
we hope a viable plan for sustainability.
Members at the Global Pregnancy Colaboratory
meeting at Oxford
UBC Department of Obstetrics & Gynaecology 2H30-4500
Oak Street, Vancouver, BC
Phone: 604-875-3054
Fax: 604-875-3212
PRE-EMPT Co-ordinating Centre
The Pre-eclampsia Foundation‟s Care Provider Page on their website ( http://www.preeclampsia.org/care-providers ) was set up over the past 12
months so as to make available and increase the visibility range of the WHO guidelines and other national guidelines. An analysis indicated that
visitors spent an average of 2:08 on the page (note the industry standard that, on average, most website visitors spend :30 on a webpage)!
In addition, Dr. You‟s Pre-ecamF-funded research on low literacy tool was published in May 2012. (You WB, Wolf MS, Bailey SC, et al. Improv-
ing patient understanding of preeclampsia: a randomized controlled trial. Am J Obstet Gynecol 2012;206:431.e1-5.)The Pre-eclampsia Foundation
also issued news about the 2012 Vision Grant winners and it can be found on their website.
Knowledge Translation (PI: Matthews Mathai)
XX FIGO World
Congress, Rome, Italy
October
7– 12,
2012
Karnataka State OB-
GYN Association
Meeting (KSOGA) &
UBC - JNMC
CLIP Planning Meeting,
Belgaum, India
October
17-22,
2012
PRE-EMPT Second
Annual Meeting, Van-
couver, Canada
November
5-8,
2012
Global Maternal Health
Conference, Arusha
International Conference
Center, Tanzania
January 15-
17, 2013
Upcoming
Activities
More updates in pictures
CAP Study: The collaboration coffee
mugs for clinics who assist with
recruitment (P.2)
CAP study: Research midwife Catherine
Parker with the first participant at
the Chris Hani Baragwanath site to
reach 32 weeks’ (P.2)
The second annual PRE-EMPT Meeting will be taking
place at the Fairmont Waterfront in Vancouver B.C.
from November 5-8th, 2012. The meeting will focus on
CLIP Feasibility Study and Trial. The first copy of the
draft agenda will be circulated shortly along with the
requests for chairs and presentations. The PRE-EMPT
Team in Vancouver is greatly looking forward to
welcoming all our esteemed guests and for engaging in
dialogue that helps us achieve our goals to improve
maternal health. If you have any questions or concerns,
please email [email protected] .
http://pre-empt.cfri.ca/
Annual PRE-EMPT Meeting, November 5-8, 2012
Fairmont Waterfront Vancouver. Photo credit:
http://www.fairmont.com/
Below: The Pre-eclampsia Founda-
tion’s Care Provider website page